Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1306125513 |
---|---|
Provider Name | Donald Patchin |
First Address | Antlers, OK 74523-1030 |
Second Address | Poteau, OK 74953-3502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2011 |
Last Update Date | 05/06/2012 |